Provider Demographics
NPI:1649465295
Name:CALABRESE, NICHOLAS MICHAEL (MFT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 LAUREL ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3949
Mailing Address - Country:US
Mailing Address - Phone:650-762-8815
Mailing Address - Fax:
Practice Address - Street 1:961 LAUREL ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3949
Practice Address - Country:US
Practice Address - Phone:650-762-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist